title: The ability of heart failure specialists to accurately predict NT-proBNP levels based on clinical assessment and a previous NT-proBNP measurement.
abstract: BACKGROUND
  The value of routine aminoterminal pro type B natriuretic peptide (NT-proBNP) measurements in outpatient clinics remains unknown.
  
  
  OBJECTIVE
  We sought to determine the accuracy with which heart failure (HF) specialists can predict NT-proBNP levels in HF outpatients based on clinical assessment.
  
  
  METHODS
  We prospectively studied 160 consecutive HF patients followed in an outpatient multidisciplinary HF clinic. During a regular office visit, HF specialists were asked to estimate a patient's current NT-proBNP level based upon their clinical assessment and all available information from their chart, including a previous NT-proBNP level (if available). NT-proBNP estimations were grouped into prognostic categories (<125, 125-1000, 1000-4998, or >/=4999 pg/mL) and comparisons made between actual and estimate values.
  
  
  RESULTS
  Overall, HF specialists estimated 67.5% of NT-proBNP levels correctly. After adjusting for clinical characteristics, knowledge of a prior NT-proBNP measurement was the only significant predictor of estimation accuracy (p=0.01). Compared to patients with a prior NT-proBNP level <125 pg/mL, physicians were 95% less likely to get a correct estimation in patients with the highest prior NT-proBNP level (>/=4999 pg/mL).
  
  
  CONCLUSIONS
  HF specialists are reasonably accurate at estimating current NT-proBNP levels based upon clinical assessment and a previous NT-proBNP level, if those levels were < 4999 pg/mL. Likely, initial but not routine NT-proBNP measurements are useful in outpatient HF clinics.
authors.affiliation: University of British Columbia.
authors.forename: Tara L
authors.initials: TL
authors.lastname: Sedlak
authors.forename: Mann
authors.initials: M
authors.lastname: Chandavimol
authors.forename: Anna
authors.initials: A
authors.lastname: Calleja
authors.forename: Catherine
authors.initials: C
authors.lastname: Clark
authors.forename: Margaret
authors.initials: M
authors.lastname: Edmonds
authors.forename: Aihua
authors.initials: A
authors.lastname: Pu
authors.forename: Karin H
authors.initials: KH
authors.lastname: Humphries
authors.forename: Andrew
authors.initials: A
authors.lastname: Ignaszewski